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Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2022; 52:1125-1133. [PMID: 34977987 DOI: 10.1007/s00595-021-02429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
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Palamuthusingam D, Nadarajah A, Johnson DW, Pascoe EM, Hawley CM, Fahim M. Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis. BMC Nephrol 2021; 22:97. [PMID: 33736605 PMCID: PMC7977605 DOI: 10.1186/s12882-021-02279-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. METHODS Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. RESULTS Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). CONCLUSION Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, Queensland, 4131, Australia.
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia.
- School of Medicine, Griffith University, 68 University Dr, Meadowbrook, QLD, 4131, Australia.
| | - Arun Nadarajah
- Department of Surgery, Sunshine Coast University Hospital, Doherty St, Birtinya, Queensland, 4575, Australia
| | - David Wayne Johnson
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Translational Research Institute, Brisbane, Australia
| | - Elaine Marie Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Carmel Marie Hawley
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Magid Fahim
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
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Palamuthusingam D, Nadarajah A, Pascoe EM, Craig J, Johnson DW, Hawley CM, Fahim M. Postoperative mortality in patients on chronic dialysis following elective surgery: A systematic review and meta-analysis. PLoS One 2020; 15:e0234402. [PMID: 32589638 PMCID: PMC7319352 DOI: 10.1371/journal.pone.0234402] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/24/2020] [Indexed: 01/11/2023] Open
Abstract
RATIONALE & OBJECTIVE The prognostic significance of dialysis-dependent end-stage kidney disease on postoperative mortality is unclear. This study aims to estimate the odds of postoperative mortality in patients receiving chronic dialysis undergoing elective surgery compared to patients with normal kidney function, and to examine the influence of comorbidities on the excess mortality risk. METHODS A systematic search of studies published up to January 2020 was conducted using MEDLINE, EMBASE and CENTRAL databases. Eligible studies reported postoperative 30-day or in-hospital mortality in chronic dialysis patients compared to patients with normal kidney function undergoing elective surgery. Two investigators independently reviewed all abstracts and performed risk of bias assessments using the Newcastle-Ottawa Scale. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Relative mortality risk estimates were obtained using random effects meta-analysis. Heterogeneity was explored using meta-regression. (PROSPERO CRD42017076565). RESULTS Forty-nine studies involving 41, 822 chronic dialysis and 10, 476, 321 non-dialysis patients undergoing elective surgery were included. Patients on chronic dialysis had a greatly increased postoperative mortality odds compared to patients with normal kidney function. The excess risk ranged from OR 10.8 (95%CI 7.3-15.9) following orthopaedic surgery to OR 4.0 (95%CI 3.2-4.9) after vascular surgery. Adjustment for age and comorbidity attenuated the excess odds but remained higher for patients on chronic dialysis, irrespective of surgical discipline. Meta-regression analysis demonstrated an inverse linear relationship between excess mortality risk and study-level mean age (slope -0.06; P = 0.001) and diabetes prevalence (slope -0.02; p = 0.001). CONCLUSIONS Patients on chronic dialysis have an increased odds for postoperative mortality following elective surgery across all surgical disciplines. This relationship is consistent among all studies, with the excess postoperative mortality attributable to end-stage kidney disease and chronic dialysis treatment may be lower among older patients with diabetes.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South and Integrated Nephrology and Transplant Services, Logan Hospital, Meadowbrook, Queensland, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- School of Medicine, Griffith University, Mount Gravatt, Queensland, Australia
| | - Arun Nadarajah
- Department of Surgery, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David W. Johnson
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Carmel M. Hawley
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Magid Fahim
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
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Imai R, Akimoto T, Kimura T, Kohara M, Shimizu T, Oka K, Shuto M, Asakura M, Nagayama I, Takeda SI, Yagisawa T, Muto S, Nagata D. Peritoneal Dialysis and Retroperitoneal Laparoscopic Radical Nephrectomy: A Favorable Experience With a Patient Complicated by Renal Cell Carcinoma. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2017; 10:1179547617746362. [PMID: 29270039 PMCID: PMC5731611 DOI: 10.1177/1179547617746362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/10/2017] [Indexed: 01/23/2023]
Abstract
Peritoneal dialysis (PD) is an accepted modality for managing end-stage kidney disease. We herein report a 75-year-old female patient on chronic PD who was complicated by renal cell carcinoma. She was successfully treated with retroperitoneal laparoscopic radical nephrectomy followed by a prompt resumption of the procedure. Various surgeries disturbing the abdominal wall integrity often disrupt the regular PD schedule, and using minimally invasive approaches is therefore an attractive therapeutic option. Our experience emphasizes the feasibility and safety of a retroperitoneal approach–based laparoscopic technique based on several empirical examples. However, systemic studies on this topic are obviously lacking, so we strongly recommend the accumulation of more cases similar to our own. Several surgical concerns that need to be dealt with among PD patients are also discussed.
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Affiliation(s)
- Reika Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Takaaki Kimura
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Marina Kohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Toshihiro Shimizu
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Kentaro Oka
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Miwa Shuto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Maki Asakura
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Izumi Nagayama
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Shin-Ichi Takeda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
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Takei K, Yamasaki M, Abe S, Yamanaka N, Sejiyama S, Narimatsu T, Hata S, Shibuya T, Hirai K, Ando T, Shin T, Mori K, Sumino Y, Nomura T, Sato F, Terachi T, Mimata H. Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors. MINIM INVASIV THER 2017; 27:153-159. [PMID: 28604288 DOI: 10.1080/13645706.2017.1335215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors. MATERIAL AND METHODS A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n = 8) or conventional laparoendoscopic nephrectomy (C-N; n = 8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups. RESULTS Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0 ± 26.7 min versus 188.6 ± 36.4 min; p = .025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4 ± 14.4 ml versus 65.6 ± 45.2 ml; p = .047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group. CONCLUSIONS Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.
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Affiliation(s)
- Kohei Takei
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Mutsushi Yamasaki
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Satoki Abe
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Naoyuki Yamanaka
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Shinya Sejiyama
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Takahiro Narimatsu
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Shinro Hata
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Tadamasa Shibuya
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Kenichi Hirai
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Tadasuke Ando
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Toshitaka Shin
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Kenichi Mori
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Yasuhiro Sumino
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Takeo Nomura
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Fuminori Sato
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Toshiro Terachi
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
| | - Hiromitsu Mimata
- a Department of Urology , Oita University Faculty of Medicine , Oita , Japan
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Omae K, Kondo T, Takagi T, Iizuka J, Kobayashi H, Hashimoto Y, Tanabe K. Surgical and Oncologic Outcomes of Laparoscopic Radical Nephrectomy for Non-Metastatic Renal Cancer in Long-Term Dialysis Patients. Ther Apher Dial 2017; 21:31-37. [PMID: 28067459 DOI: 10.1111/1744-9987.12500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 01/20/2023]
Abstract
This study aimed to compare the outcomes of laparoscopic radical nephrectomy (LRN) between patients undergoing dialysis for ≤240 and >240 months. Data from all dialysis patients with non-metastatic renal cell carcinoma (RCC) treated with LRN between 2008 and 2015 in our hospital were evaluated retrospectively. Patients were divided into two groups, shorter- and longer-term dialysis patients, according to the preoperative duration of dialysis (≤240 vs. >240 months). Of 174 patients, 58 (33.3%) were on longer-term dialysis. Perioperative minor complications were significantly more frequent in the longer-term dialysis patients (P = 0.03). There was no significant difference between the two groups in other perioperative outcomes. Patients on longer-term dialysis more frequently had pathologically advanced RCC (P = 0.009) with poorer prognosis (P = 0.005). LRN for RCC in longer-term dialysis patients appears to be safe and feasible; however, careful follow-up is needed because these patients tend to have poorer prognosis.
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Affiliation(s)
- Kenji Omae
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Feasibility and safety of laparoscopic nephrectomy in uremic patients with end-stage renal disease. Urologia 2015; 83:40-2. [PMID: 26616459 DOI: 10.5301/uro.5000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The purpose of this study was to analyse the feasibility and safety of laparoscopic radical nephrectomy (LRN) vs. open radical nephrectomy (ORN), in terms of perioperative and postoperative outcomes, in uremic patients. METHODS Between September 2007 and December 2013, 19 patients with end-stage renal disease (ESRD), who underwent LRN or ORN for chronic pyelonephritis, renal calculi, hydronephrosis, renal tumors, complicated cyst, or associated polycystic kidney, were retrospectively analysed. All patients with complete preoperative clinical and intraoperative parameters, including age at surgery, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, surgical technique, operation time, complications, were available for further analyses. The 30-day complication rate in both groups was retrospectively review and graded according to the modified Clavien System in five grades. RESULTS Overall, nine (47.3%) vs. 10 (52.7%) patients underwent LRN vs. ORN, respectively. The mean ASA score (2.7 ± 0.8 vs. 2.9 ± 0.7) did not show statistically significant differences in both groups (p = 0.632). None of the patients in G1 was converted to open surgery for intraoperative complications or CO2 retention. The estimated blood loss was 223 ± 155 mL in G1 and 455 ± 134 mL in G2 (p<0.005). Both groups were comparable with regard to mean operation time. The mean hospital stay was 5.95 ± 1.85 days in G1 and 8.10 ± 1.67 days in G2 (p<0.001). CONCLUSIONS The present study revealed that laparoscopic surgery in uremic patients might be performed safely under the expertise of an experienced laparoscopic team. This surgical technique is a minimally invasive treatment, reduces blood loss, shortens postoperative hospital stay, minimizes wound pain, and encourages an earlier return to normal activity.
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Sherman RA. Briefly Noted. Semin Dial 2012. [DOI: 10.1111/j.1525-139x.2012.12019.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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